2016-10-03T15:24:35-05:00 2016-02-29 310800053 CLARK SCHAEFER HACKETT & CO 10100 INNOVATION DR SUITE 400 DAYTON OH 45342 990 2015-03-01 611672591 ULLIMAN SCHUTTE CONSTRUCTION LLC GROUP HEALTH INSURANCE TRUST ULLI 9379109900 9111 SPRINGBORO PIKE MIAMISBURG OH 45342 CYNTHIA MARTIN TRUST COMMITTEE MEMBER 9379109900 2016-09-19 1 STEPHANIE R PYLES CPA P00613386 9372260070 2016-09-19 2015 2017-02-10 21:41:12Z CYNTHIA MARTIN 9111 SPRINGBORO PIKE MIAMISBURG OH 45342 1946482 0 X WWW.ULLIMANSCHUTTE.COM X 2012 OH TO PROVIDE LIFE, HEALTH, ACCIDENT INSURANCE, OR OTHER BENEFITS FOR EMPLOYEES 2 0 0 0 0 0 0 0 1925891 1946482 0 0 0 0 1925891 1946482 0 0 1403838 1453733 0 0 0 0 0 522053 492749 1925891 1946482 0 0 59622 60418 59541 60337 81 81 TO PROVIDE LIFE, HEALTH, ACCIDENT INSURANCE, OR OTHER BENEFITS FOR EMPLOYEES OF ULLIMAN SCHUTTE CONSTRUCTION, LLC. 0 0 PROVIDED LIFE, HEALTH, ACCIDENT INSURANCE, AND OTHER BENEFITS FOR EMPLOYEES OF ULLIMAN SCHUTTE CONSTRUCTION, LLC. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 X 2 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 X CYNTHIA MARTIN 9379109900 9111 SPRINGBORO PIKE MIAMISBURG OH 45342 CYNTHIA MARTIN-SHISHOFF TRUST COMMITTEE MEMBER 1.00 40.00 X X 0 201864 17046 JOHN COFFIN TRUST COMMITTEE MEMBER 1.00 40.00 X X 0 216866 28209 0 418730 45255 0 0 1 0 CIGNA C/O 9111 SPRINGBORO PIKE MIAMISBURG OH 45342 CLAIMS ADMINISTRATION 124453 1 X EMPLOYER CONTRIBUTIONS 525100 1489868 1489868 EMPLOYEE CONTRIBUTIONS 525100 456614 456614 1946482 1946482 1946482 0 0 1453733 STOP LOSS & CLAIMS ADMI 492749 1946482 81 81 59541 60337 59622 60418 59541 60337 59541 60337 X 0 0 0 0 81 81 81 81 59622 60418 0 0 X X 0 1 X 1 0 0 1946482 0 1946482 0 1946482 1946482 0 1946482 0 1946482 0 0 0 CYNTHIA MARTIN-SHISHOFF TRUST COMMITTEE MEMBER 0 164114 0 37750 0 0 0 11133 0 5913 0 218910 0 0 JOHN COFFIN TRUST COMMITTEE MEMBER 0 154040 0 62826 0 0 0 10777 0 17432 0 245075 0 0 FORM 990, PART VI, SECTION A, LINE 8B THERE ARE NO COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11 THE TRUST COMMITTEE WILL REVIEW THE 990 FOR ACCURACY AND COMPLETENESS BEFORE FILING FORM 990. FORM 990, PART VI, SECTION B, LINE 12C THE TRUSTEES ARE REQUIRED TO COMPLY WITH THE REQUIREMENTS OF THE EMPLOYEE RETIREMENT INCOME SECURITY ACT OF 1974 (ERISA), AS WELL AS THE INTERNAL REVENUE CODE (IRC), AND THE ATTENDANT REGULATIONS ADOPTED PURSUANT TO BOTH EIRSA AND THE IRC, WITH RESPECT TO NON-EXEMPT PROHIBITED TRANSACTIONS. AS SUCH, THE TRUSTEES WOULD REPORT ANY POSSIBLE CONFLICTS OF INTEREST TO SENIOR MANAGEMENT OF THE SPONSOR. FORM 990, PART VI, SECTION C, LINE 19 THE FORMS ARE MADE AVAILABLE UPON REQUEST. FORM 990-T: INVESTMENT INCOME OF A 501(C)(9) ORGANIZATION IS REQUIRED TO BE REPORTED ON THE FORM 990-T. DURING THE FISCAL YEAR ENDED FREBRUARY 29, 2016, THE TRUST DID NOT EARN ANY INVESTMENT INCOME. THEREFORE, A FORM 990-T WAS NOT REQUIRED TO BE FILED. FORM 990, PART XII, LINE 2C: THE TRUSTEES OF THE PLAN ARE RESPONSIBLE FOR OVERSIGHT OF THE INDEPENDENT AUDIT & THE SELECTION OF THE INDEPENDENT AUDITOR. THIS PROCESS IS CONSISTENT WITH THE PRIOR YEAR. ULLIMAN SCHUTTE CONSTRUCTION LLC 9111 SPRINGBORO PIKE MIAMISBURG OH 45342 CONSTRUCTION OH N/A S 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0